大型海綿竇動脈瘤管道栓塞術之處置方法：病例回顧

Strategies for Managing Carotid Cavernous Fistulas Before and After Pipeline Embolization of Large Cavernous Aneurysms: A Review of Consecutive Cases

本病例報告討論了在大型海綿竇動脈瘤管道栓塞（PED）前後管理頸動脈海綿竇瘺（CCFs）的策略。報告了兩個病例：病例報告強調了根據個體患者解剖結構和動脈瘤特徵量身定制治療方案的重要性，並強調需要仔細規劃以減輕動脈瘤破裂和CCF發展的併發症。海綿竇頸動脈瘤（CCA）雖然通常具有較低的嚴重併發症風險，但仍可能導致大型或巨大動脈瘤破裂或血栓性動脈瘤，進而引發神經功能缺損。傳統的線圈栓塞術僅有40%-60%的成功率，儘管球囊輔助方法可以提高成功率，但也會增加併發症風險且不會增加線圈填充密度。管道栓塞裝置（PED）是一種更安全且更有效的治療方法。然而，PED用於直接頸動脈海綿竇瘺（CCF）的情況較少見。本研究報告了兩例PED治療CCA前後的直接CCF病例，並比較了經動脈和經靜脈線圈栓塞的治療策略差異。第一個病例是一名71歲的女性，患有右側海綿竇頸動脈瘤（CCA），導致直接CCF，採用經動脈線圈栓塞和管道栓塞裝置（PED）進行治療。第二個病例是一名62歲的女性，左側CCA在PED置入後出現CCF，以經靜脈線圈栓塞進行治療。本篇透過比較此二病例治療策略，強調了管道栓塞裝置在治療頸動脈海綿竇瘺中的應用及其效果。

This case report discusses management strategies for carotid cavernous fistulas (CCFs) before and after Pipeline embolization of large cavernous aneurysms. Two cases are presented: the first case is a 71-year-old woman with a right cavernous carotid aneurysm (CCA) resulting in a direct CCF. She was treated with transarterial coiling and Pipeline Embolization Device (PED) placement. The second case is a 62-year-old woman with a left CCA developing a direct CCF post-PED placement. She was treated with transvenous coil embolization. Both cases highlight different treatment strategies, demonstrating the efficacy of using PEDs in conjunction with coil embolization. The case report underscores the importance of tailored approaches based on individual patient anatomy and aneurysm characteristics, emphasizing the need for careful planning to mitigate complications including aneurysm rupture and CCF development.